Children thrive with initially refused donor hearts.

Donor hearts for babies that were rejected initially as less than perfect turned out to be good enough for 21 of 29 children studied by doctors at California's Loma Linda University Medical Center. Those 21 children were alive and the initially scorned hearts were beating normally during a seven-year follow-up period, author Leonard L. Bailey, M.D., reported last month at the Society of Thoracic Surgeons meeting in San Francisco.

Those survivors offer proof that there is almost no valid reason to reject a pediatric donor heart, he told MedPage Today. "There was no difference in survival between those transplanted with donor hearts previously refused and those who received hearts primarily offered." Dr. Bailey said. By accepting previously refused hearts, the supply of donor hearts could be increased by as much as third, he estimated.

Dr. Bailey reviewed United Network for Organ Sharing databases from July 2000 through March 2008 to examine the outcomes of donor hearts that had previously been refused one or more times because of UNOS criteria for organ quality. He compared outcomes with a cohort of patients transplanted with primarily offered organs. Eighty-four patients were given the primarily offered hearts and 29 the previously refused organs. The operative survival was 93% in the primarily offered group versus 92% in the refused organ group. More than 70% of those in each group are living.

Dr. Bailey said that "over the last eight years 6,000 pediatric hearts have been offered, but only 3,943 have been used. We have lost about a third of the offered hearts, usually because they were refused on the basis of UNOS codes."